A radiation burn is damage to the skin or other biological tissue caused by exposure to radiation. The radiation types of greatest concern are thermal radiation, radio frequency energy, ultraviolet light and ionising radiation.
Radiation therapy or radiotherapy is the medical use of ionising radiation, generally as part of cancer treatment to control or kill malignant cells. Radiation therapy may be curative in a number of types of cancer if the cancer cells are localised to one area of the body. It may also be used as part of curative therapy, to prevent tumour recurrence after surgery to remove a primary malignant tumour (for example, early stages of breast cancer). Radiation therapy is synergistic with chemotherapy, and has been used before, during and after chemotherapy in susceptible cancers.
Radiation therapy has several applications in non-malignant conditions, such as the treatment of trigeminal neuralgia, acoustic neuromas, severe thyroid eye disease, pterygium, pigmented villonodular synovitis and prevention of keloid scar growth, vascular restenosis, and heterotopic ossification. However, its use in non-malignant conditions is limited, partly by worries about the risk of radiation-induced cancers.
Radiation dermatitis or radiodermatitis is a skin disease associated with exposure to ionising radiation. Radiation dermatitis occurs to some degree in most patients receiving radiation therapy, with or without chemotherapy. As many as 95% of patients treated with radiation therapy for cancer will experience a skin reaction. Some reactions are immediate, while others may be later (e.g. months after treatment) (Porock et al 2009). Radiation dermatitis generally manifests within a few weeks after the start of radiotherapy, while typically presenting as red patches (erythema). It may also present with desquamation or blistering.
The reaction may become more severe during the treatment and for up to about one week following the end of radiation therapy. The skin may ultimately thin and begin to weep because of loss of integrity of the epithelial barrier and decreased oncotic pressure referred to as desquamation. Whilst this phase is uncomfortable, recovery is usually quick. Skin reactions tend to be worse in areas where there are natural folds in the skin, such as underneath the female breast, behind the ear and in the groin. Over time, the irritated skin will heal, but may not be as elastic as it was before.
Radio dermatitis can be painful and embarrassing and has been associated with decreased quality of life (Fisher et al 2000). The appearance and development of radiation dermatitis depends on many factors including the applied dose of radiation, type of radiation, energy level of the dose, total period of treatment, size of area treated, fractionation and factors that vary from individual to individual. Severe radiodermatitis necessitates treatment modifications or delays, which may compromise the efficacy of radiotherapy (Hymes et al 2006).
Given the scope and severity of radiodermatitis, it is crucial that oncology nurses are familiar with the clinical presentation and evidenced-based interventions for radiodermatitis.
However, an investigative survey by D'haese et al (2005) found that there is wide discrepancy between nursing interventions for the prevention and management of radiodermatitis. D'haese interviewed radiation oncology nurses in Belgium and found only a small to moderate level of agreement between nurses regarding the prevention and management of radiodermatitis. The greatest variation was between preventative practices. These results suggest that there is confusion among oncology nurses (and likely their patients) regarding the prevention and management of radiodermatitis.
Numerous treatments have been suggested for the prevention and management of radiodermatitis. Among the suggested treatments are: ascorbic acid, vitamin D, aloe vera gel, chamomile and calendula creams and almond ointment (Kassab et al 2009), moisturisation with a non-scented, hydrophilic, lanolin-free cream, topical steroids, washing gently with a mild soap or shampoo (Bolderston et al 2006). Gentle washing has been found to be more effective in the prevention and treatment of radiodermatitis than topical aloe vera (Richardson et al 2005).
However, there is very little scientific support for any of these treatments. Thus there is a need for a topical formulation that is effective both in prophylaxis and treatment of radiation dermatitis and is simple to use.
At the present time the standard of care for radiation dermatitis is a clean dry dressing. However, this approach does not provide soothing or actively assist the healing of the damaged area.
Here we present a novel topical formulation for the prophylaxis and treatment of radiation dermatitis that has been shown to reduce the likelihood of developing grade 3 or 4 radiation dermatitis (on the RTOG or NCI scales). Furthermore, the treatment is easy to use by the patient.